Background/Objectives:The presence of paraneoplastic syndromes (PNS) in patients with renal cell carcinoma (RCC) is associated with worse survival; however, little is known about whether resolution of PNS after intervention has any prognostic value. We sought to determine if resolution of PNS by one year after cytoreductive nephrectomy was significantly associated with improved overall survival (OS) and cancer-specific survival (CSS).Methods:We retrospectively reviewed a prospectively maintained nephrectomy database for patients with any histology metastatic RCC (mRCC) who underwent nephrectomy between 2000 and 2022. Patients with the necessary laboratory studies available within 90 days before and by one year after surgery were included for study. PNS resolution was defined as an abnormal value compared to established laboratory cutoffs by one year after surgery. Multiple PNS in one patient was allowed, and resolution of each PNS was measured separately. OS and CSS were assessed using Kaplan–Meier curves and Cox proportional hazards models.Results:A total of 253 patients met inclusion criteria. A total of 177 patients (70.0%) met criteria for at least one PNS resolution by one year. Five-year OS and CSS rates were 15.7% and 36.2% for no PNS resolved, 24.5% and 31.6% for 1 PNS resolved, and 43.0% and 58.2% for ≥2 PNS resolved, respectively (p< 0.001). On multivariable analysis, no PNS resolution was associated with worse OS (HR 2.75,p< 0.001) and CSS (HR 2.62,p< 0.001) compared to ≥2 PNS resolved.Conclusions:Resolution of preoperative PNS abnormalities by one year following surgery is associated with improved OS and CSS in patients with mRCC.
背景/目的：肾细胞癌患者伴发副肿瘤综合征与较差的生存预后相关，但关于干预后副肿瘤综合征的缓解是否具有预后价值，目前知之甚少。本研究旨在探讨细胞减灭性肾切除术后一年内副肿瘤综合征的缓解是否与总生存期及癌症特异性生存期的改善显著相关。方法：我们回顾性分析了一个前瞻性维护的肾切除术数据库，纳入2000年至2022年间接受肾切除术、任何组织学类型的转移性肾细胞癌患者。研究对象需在术前90天内及术后一年内完成必要的实验室检查。副肿瘤综合征缓解定义为术后一年内异常实验室指标恢复至既定临界值以下。允许同一患者存在多种副肿瘤综合征表现，并对每种综合征的缓解情况分别进行评估。采用Kaplan-Meier曲线和Cox比例风险模型评估总生存期和癌症特异性生存期。结果：共253例患者符合纳入标准。其中177例患者在术后一年内至少有一种副肿瘤综合征达到缓解标准。未缓解组、缓解1种组及缓解≥2种组的五年总生存率分别为15.7%、24.5%和43.0%，五年癌症特异性生存率分别为36.2%、31.6%和58.2%（p<0.001）。多变量分析显示，与缓解≥2种副肿瘤综合征的患者相比，未缓解者的总生存期风险比显著升高，癌症特异性生存期风险比亦显著升高。结论：转移性肾细胞癌患者术后一年内术前副肿瘤综合征异常指标的缓解与总生存期及癌症特异性生存期的改善显著相关。
Paraneoplastic Resolution Holds Prognostic Utility in Patients with Metastatic Renal Cell Carcinoma
肿瘤(癌症)患者之家